Adults In Residential Care Facilities Research Articles

Outdoor stays-A basic human need except for older adults in residential care facilities? Researcher-practitioner interaction crosses zones and shows the way out.

The aim of this discussion paper is to show the way to the outdoors by shedding light on conditions in the physical environment enabling outdoor stays for older adults living in residential care facilities (RCFs). The origin was that outdoor stays is a basic human need and applies to everyone. However, despite extensive research on the health-promoting values of contact with the outdoors, it seems that for older adults in RCFs this is not met because they often have difficulty getting outdoors on their own. Therefore, the access to and the conditions of outdoor environments are discussed and exemplified through two cases based on evidence-based approaches, namely the principal model of four zones of contact with the outdoors, and the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM). An interdisciplinary team, including both researchers and practitioners highlights future directions by showing the way to the outdoors on a national level with six suggested points. As a reader, you will gain increased knowledge about environmental qualities that support outdoor stays as well as initiatives that are needed to achieve equal conditions related to outdoor stays in RCFs.

Factors Promoting a Sense of Home Among Older Adults in Residential Care Facilities in Italy.

Understanding the housing needs of older adults is crucial for policy makers, service providers, and professional carers. Evidence about the factors that contribute to older adults' "sense of home" and their practical and policies implications are lacking. Semi-structured interviews were conducted with 78 community-dwelling older adults to investigate which structural and organizational requirements and relational-affective environments could contribute to their experiencing a sense of home. Through inductive content analysis 119 subcategories were derived and grouped into eight main categories: being considered as a person; a safe, quiet, welcoming, and personalizable environment; meaningful relationships; optional and stimulating activities; active involvement in the organization within the facility; competent care personnel; preserving life memories; facility open and integrated with the community. Findings suggest that multiple factors might influence "feeling at home," and many strategies can be adopted to facilitate older adults' successful adaptation. It is important that healthcare organizations consider these factors from a person-centered care perspective, and that care staff are trained in this type of care to enhance staff decision-making and older adults' wellbeing.

Adaptation to Residential Care: Voices from New Zealand

This article explores the adaptation process of older adults in residential care facilities in New Zealand. Through a phenomenological approach, this study provides clarity on how older adults adjust in residential care despite losses and challenges. Qualitative data on 24 older adults, 6 residential care facilities, and 10 staff were collected. Utilising qualitative software the following were identified: loss, support, acceptance and meaningful support. Initially, the unfamiliar environment and faces, structured routines, lack of interaction, absence of familiar activities, and limited visits from family and friends increased residents’ feelings of loneliness with institutionalisation. In time, they adapted to the routines and came to accept the facilities as, if not “home,” then “like home.” Participation in activities and support from staff and family contributed to this process. Activities can facilitate adjustment by promoting social contact, providing meaning and helping residents to establish new identities. The participants’ stories revealed that, despite the challenges of relocation, they adapted well to the residential environment.

Stemming the "ageism pandemic": A qualitative inquiry with older adults in residential care facilities during the Covid-19 outbreak.

The Covid-19 pandemic added to collective concerns, making health risks salient especially for the older population. The health emergency exacerbated an already widespread negative representation of aging, and phenomena such as ageism. With the present qualitative inquiry, 21 episodic interviews were collected with the aim of understanding the experience of older adults in residential care facilities, exploring their ideas of aging and the viewpoints that helped them to respond to the pandemic successfully. A thematic analysis was conducted using NudIst software. The results show that participants described multiple personal and relational resources they used to cope with the pandemic, and they were able to express counter-narratives to the ideas of aging as coinciding with decline, and of lockdown as a source of distress alone. The paper concludes with reflections on the relevance of research capable of challenging unhelpful dominant discourses and averting the risk of them turning into negative prophecies.

Associations of living in residential care facilities with participation in physical activities among older adults in the United States

Abstract Background: Physical activity (PA) is important for the healthy aging period, and existing research indicates that older adults in residential care facilities (RCFs) are less physically active compared with community-dwelling, but sociodemographic and health-related characteristics were not controlled. Lower PA levels might be due to older age and worse health conditions of the RCFs residents. Objective: This study examined the association between residential status (RCF vs. community-dwelling) and participation in PA, in a sample of 4009 older adults (65 and above) in the National Health and Aging Trends Study (NHATS), adjusting for sociodemographic and health-related characteristics. Methods: The current study used Rounds 8 and 9 of the NHATS which was collected in 2018 and 2019. We conducted design-based logistic regression analyses to determine whether residential care status was significantly associated with participation in walking exercises and vigorous activities, and controlled for sociodemographic and health-related characteristics. Results: Using multivariable logistic regression models, older adults in RCFs (n=214) were more likely to participate in walking exercises (adjusted odds ratios=1.94, P<0.01) and equally likely to participate in vigorous activities (adjusted odds ratios=1.04, P=0.84) than community-dwelling (n=3795). Conclusions: Our finding adds new evidence to the conventional thinking about the potential effect of RCFs on PA. Further research is needed to address the underlying mechanisms.

Feasibility and acceptability of an education and training e-resource to support the sexuality, intimacy and relationship needs of older care home residents: a mixed methods study.

sexuality, intimacy and relationship needs are often a neglected aspect of the care of older adults in residential care facilities. Improving awareness, knowledge and improving attitudes about these needs among care staff could enhance quality of care and lead to better outcomes for residents. to evaluate the feasibility and acceptability of a co-designed education and training e-resource to help care staff support their residents' sexuality, intimacy and relationship needs. we delivered the education and training e-resource to five UK care homes over a 6-month period in a pre-post mixed methods study using surveys, focus groups and individual interviews. fifty-nine members of staff from participating care homes undertook the education and training e-resource. 18/59 (31%) of participants completed all six modules and the pre-post surveys. Eleven participants participated in focus groups/interviews to explore experiences of using the e-resource. The e-resource was successfully implemented in the study homes and found to be acceptable. We found preliminary evidence of positive changes in staff attitudes. Factors that facilitated implementation included support from the care home manager. Barriers identified included IT infrastructure and technology. the findings provide initial evidence that a co-designed education and training e-resource raised awareness of, and improved attitudes towards, older adults' sexuality and intimacy needs. This work provides the foundation for a next phase to establish the effectiveness of the e-resource on staff practice and resident outcomes.

Bolus Texture Testing as a Clinical Method for Evaluating Food Oral Processing and Choking Risk: A Pilot Study.

Choking on food is a leading cause of accidental death in several populations, including children, people with intellectual/developmental disability, and older adults in residential care facilities. One contributor to choking risk is incomplete oral processing and failure to convert food to a cohesive, nonsticky bolus with a maximum particle size that will not block the airway. Clinical tests of mastication do not evaluate properties of chewed food boluses. We characterized expectorated boluses, after oral processing, using methods developed by the International Dysphagia Diet Standardisation Initiative (IDDSI). Seventeen adults without dysphagia (seven women and 10 men), aged 23-55 years, chewed samples of a cracker, a raw baby carrot, and a circular, dome-shaped gummy candy. Chewing metrics were obtained up to the point when the person indicated that they were ready to swallow. The bolus was then either expectorated or swallowed; IDDSI tests were used to characterize the expectorated boluses. Measures of chewing did not differ between spit and swallow conditions. Expectorated cracker and carrot boluses had maximum particle size consistent with IDDSI Level SB6 Soft & Bite-Sized foods or lower. The gummy candy samples remained at IDDSI Level RG7 Regular food consistency. This study suggests that expectorated ready-to-swallow boluses are representative of boluses that are swallowed and that oral processing in adults without dysphagia typically results in boluses at IDDSI's Level SB6 or lower. IDDSI's testing methods provide a practical method for evaluating oral processing by characterizing expectorated ready-to-swallow boluses and may guide food texture recommendations for persons who have increased risk of choking.

Influences of Prejudice and Stereotyping in the Direct Care Workforce

As we age, physical and neuromuscular function declines gradually. Exercise is a therapy to improve neuromuscular ability. Pre-clinical models are needed to understand molecular mechanisms contributing to age-associated functional decline and how exercise affects that downward trajectory. Our goal was to compare the differences in effects of two validated mouse models of endurance exercise designed to mimic human training studies: high intensity interval training (HIIT) and voluntary wheel running (VWR). We hypothesized that both adult and older adults (10 and 26 months old at end, respectively: 10m and 26m) would respond to both exercise regimens by improving or maintaining exercise/physical capacity, but that adult mice would benefit more. We randomly assigned male C57BL/6 mice into experimental groups: 10m: (VWR, HIIT, sedentary control, CON, n=8 per group), and 26m (VWR, n=8, HIIT, n=10). We measured functional ability (pre- and post-intervention) using CFAB (comprehensive functional assessment battery), our composite scoring system (grip strength, inverted cling, treadmill endurance, activity rate, rotarod), tracked body composition (EchoMRI), and measured muscle wet mass. We found that significant retention of ability (CFAB difference, repeated measures ANOVA, p<0.05) and fat percentage (ANOVA., %change: 10m: CON +125%, HIIT +101%, VWR +52%; 26m: VWR -42%, HIIT +26%, p<0.05) was promoted by both exercise modalities compared to control, and furthermore HIIT may have better efficacy in the adult versus the older mice. In conclusion, both exercises are valid models with derived benefits as expected in similar human studies. We anticipate future work using these models to undertake mechanistic investigations.

Designing virtual natural environments for older adults in residential care facilities

BACKGROUND: Spending time in natural environments is beneficial for mental health and cognitive function. Unfortunately, many elderly citizens, who would potentially gain from these beneficial effects, have limited or no access to natural environments. Virtual reality may provide the experience of being present in a natural environment without the need of transportation. OBJECTIVE: The purpose of the present study was to acquire an understanding of how residents and staff at a residential care facility may use and experience different virtual natural environments, and thus aid the design of virtual natural environments. METHODS: We used qualitative method, collecting data through interviews and observations. The data was analyzed using qualitative content analysis. RESULTS: Exposure to virtual natural environments provoked various emotional reactions, and promoted skill development and social interaction among participants. The staff perceived virtual natural environments as potentially useful for, for example, improving residents’ anxiety. We identified several user interface improvements. CONCLUSIONS: The present study discusses how various aspects of virtual natural environments work in relation to the experience of a user and how this might affect wellbeing in older adults. These aspects may be valuable to consider in the design of virtual natural environments for use at residential care facilities.

The Influence of Physical Environmental Factors on Older Adults in Residential Care Facilities in Northeast China.

To evaluate the aspects of the objective physical environments of five residential care facilities (RCFs) for older adults and the residents' subjective perceptions of these aspects. The physical environment in RCFs impacts the health and comfort of the residents. However, the design standards for RCFs lack details which can result in insufficient living conditions. Through questionnaire surveys, older adults' satisfaction on the degree of the light, acoustic, and thermal environment in the facilities was obtained. Indoor lighting condition was measured by an illuminance meter in lux, sound pressure level (SPL) with sound level meters in dBA, and temperature in °C with a temperature data logger, and an audiometer was used to test the hearing of the older adults. A total of 480 questionnaires were obtained. Results show that (a) older adults need an appropriate light environment to avoid the negative impact of limited light, (b) poor acoustic environment could affect their mood and health, and (c) when the room temperature is within the range of 20-26 °C (68-78.8 °F), they feel most comfortable. When the appropriate temperature and humidity, balanced illumination, and SPL meet the needs of older adults, it can provide a more comfortable physical environment for them. Examining the interaction between the physical environmental factors that affect older adults in RCFs is important for the design of residential housing and provides more theoretical support for research on the influence of the physical environment on the quality of life of older adults.

Effects of Horticultural Activities on Attitudes toward Aging, Sense of Hope and Hand-Eye Coordination in Older Adults in Residential Care Facilities.

This study investigated the effects of an 8-week horticultural activity intervention on attitudes toward aging, sense of hope, and hand–eye coordination in 88 older adults in residential care facilities. In the experimental group, the mean score for “attitudes toward aging” increased from 3.81 before the intervention to 4.74 points after the intervention (standard deviation SD = 0.24 and 0.27, respectively), and the control group dropped from 3.75 to 3.70 (standard deviations, respectively SD = 0.27 and 0.28). The mean score for “sense of hope” increased from 3.28 before the intervention to 3.81 points after the intervention (SD = 0.49 and 0.26, respectively). In contrast to the control group, the mean score gradually declined from 3.26 to 3.16 points (standard deviation SD = 0.54 and 0.48, respectively). In the test of hand–eye coordination, the time required to complete the cup stacking test significantly decreased from 33.56 to 25.38 s in the experimental group but did not significantly change in the control group. Generalized estimating equation analysis revealed a significant interaction between group and time (p < 0.001). The data trends revealed significant differences in outcomes between the experimental group and the control group. At 3 months after the end of the study, the effect size in the experimental group remained higher than that in the control group.

Association Between Falls and Chronic Health Conditions Among Adults in Residential Care Facilities: Analysis of the National Survey of Residential Care Facilities (NSRCF) Data

In the United States, falls are the leading cause of both fatal and non-fatal injuries among adults aged 65 and older...

Personal and Environmental Contributors to Sedentary Behavior of Older Adults in Independent and Assisted Living Facilities.

Sedentary behavior is associated with negative health outcomes and unhealthy aging. Older adults are the most sedentary age group, and decreasing sitting time represents an intervention target for improving health. Determinants of sedentary behavior have been examined in older adults living in their own homes, yet less is known about sedentary behavior of older adults in residential care facilities. The purpose of this study was to explore factors contributing to sedentary behavior among residents of independent and assisted living facilities. We conducted eight focus groups with residents (n = 44) and semi-structured interviews with staff (n = 6) across four living facilities. Audio recordings were transcribed and analyzed using an iterative, inductive approach. Three salient themes were identified. Residents and staff both viewed sedentary behavior negatively unless it was in the context of social engagement. Additionally, fear of falling was discussed as a significant contributor to sedentary behavior. Finally, residents felt the community living environment contributed to their sedentary behavior while staff did not. Our findings provide valuable insight for designing targeted interventions for older adults in residential facilities and suggest thinking beyond the individual and considering environmental influences on sedentary behavior in the residential care setting.

Fiberoptic endoscopic evaluation of swallowing and videofluoroscopy swallowing assessment in adults in residential care facilities: a scoping review protocol.

This scoping review will identify and explore existing evidence on the use of instrumental swallowing assessment in the diagnosis and management of dysphagia in adults living in residential care facilities. Oropharyngeal dysphagia is prevalent among adults living in residential care facilities. Videofluoroscopy and fiberoptic endoscopic evaluation of swallowing are instrumental assessment procedures commonly utilized in the evaluation of oropharyngeal dysphagia in hospital and community settings. However, little is known about the use of these procedures in residential care facilities. To ensure evidence-based assessment of oropharyngeal dysphagia and to guide future research, exploration of the current use and clinical utility of videofluoroscopy and fiberoptic endoscopic evaluation of swallowing in residential care facilities is needed. Published and gray literature written in English from 2000 onward that discusses instrumental swallowing assessment of adults in residential care facilities will be included in the review. A three-step search strategy will be used to explore relevant literature. All citations and articles retrieved during the searches will be imported into a software application for systematic reviews. Once duplicates are removed, two reviewers will screen the titles and abstracts against predefined inclusion criteria. Information will be extracted from literature that meets the selection criteria using a purposefully developed charting form. The search strategy and results will be illustrated through a Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram. Key findings and their relationship to the research questions will be summarized in a chart and discussed in interpretive narrative form.

A qualitative examination of policy and structural factors driving care workers\u2019 adverse experiences in long-term residential care facilities for older adults in Cape Town

BackgroundThere is lack of adequate training and policy support for employed care workers (CWs) employed in the South African (SA) older persons’ sector. Existing literature neglects the influence of training and policy support on CWs’ experiences in long-term care (LTC) for older adults in residential care facilities (RCFs). We investigated the ways in which CWs’ experiences are rooted in the lack of adequate training and policy support.MethodsQualitative data was collected through focus group (FG) interviews with 32 CWs employed in RCFs in the City of Cape Town. Data was also collected using semi-structured interviews with representatives of five RCFs for older adults and four training organisations providing CW training in the City of Cape Town, South Africa.ResultsDespite some positive caregiving experiences, CWs face role ambiguity and experience care work as a ‘career-less job’. They also face poor employment conditions, negative interpersonal relations at work, and role overload. They are not coping with the demands of LTC due to role overload, and lack of basic caregiving skills, coping skills and socio-emotional support. Their motivation to cope and provide quality care is hamstrung by their experiences of role ambiguity, poor employment conditions, negative interpersonal relations at work, and lack of career growth opportunities.ConclusionsFindings suggest that CWs’ experiences derive from the policy and structural context of caregiving. Policy inadequacies and lack of structural support create conditions for adverse conditions which negatively impact on CWs motivation and ability to cope with the demands of LTC. Lack of policy implementation presents structural barriers to quality LTC in the older persons’ sector. Implementation of policies and systems for professionalising care work is long overdue.

Attitudes and beliefs of healthcare workers about influenza vaccination.

Annual influenza vaccination is recommended for all healthcare workers (HCWs) to help reduce the risk of contracting the virus and transmitting it to vulnerable people, especially older adults in residential care facilities. Vaccination uptake among HCWs remains low. To investigate HCWs' attitudes towards, and beliefs about, seasonal influenza vaccination in a residential care facility for older adults in the Republic of Ireland. Data were collected using a self-administered questionnaire. A total of 95 questionnaires were distributed, and 35 (37%) HCWs completed and returned them. During the 2016-17 flu season, 20 (57%) respondents were vaccinated. Primary predictors of vaccination acceptance were the belief that being healthy should not mitigate against requiring the vaccine ( r =0.7, P =0.01), protection of self and family ( r =0.67, P =0.01), protection of patients ( r =0.592, P =0.01) and agreement with mandatory vaccination ( r =0.351, P =0.039). Reasons for vaccination avoidance were misconceptions about the need for vaccination among healthy HCWs (67%), efficacy of the vaccine (60%), lack of trust in the vaccine (47%) and a belief that the vaccine may cause flu (47%). Addressing HCWs' beliefs relating to the personal benefits of vaccination while simultaneously correcting misconceptions may help to increase uptake among those working in residential care settings for older adults.

What is known about the spirituality in older adults living in residential care facilities? An Integrative review.

To synthesize evidence regarding the spiritual needs and care of older adults living in residential care facilities from the perspectives of older adults and nurses or caregivers. Integrative review of literature. Literature search was conducted using CINAHL Plus with Full Text via EBSCO, Scopus, PubMed, PsychInfo, Web of Science, and ProQuest Social Science Databases from March to December 2017. This integrative review utilised the Whittemore and Knafl framework and PRISMA in the selection of eligible articles. Quality of the articles was evaluated using the Mixed Method Appraisal Tool. Seven articles were reviewed and analysed. There is limited evidence \and no agreed definition of spiritual needs and care of older adults living in residential care facilities. Spiritual needs of older adults in residential care facilities is a psycho-social, religious and existential construct. Spiritual care in residential care facilities is linked to information gathering, religious guidance, maintaining family connections, providing companionship, discussing end of life issues, and providing counseling. Older adults highly value the role of nurses and caregivers in fulfilling their spiritual needs and providing spiritual care. However, nurses and caregivers perceived arranging a referral to a religious advisor as the main aspect of spiritual care. Therefore, nurses', caregivers', and older adults' views on spiritual care differed to some extent. The practical aspects of spiritual needs assessment and spiritual care provision requires further investigation, which is essential to improve the effectiveness of service delivery in residential care facilities.

Costs of potentially inappropriate medication use in residential aged care facilities

BackgroundThe potential harms of some medications may outweigh their potential benefits (inappropriate medication use). Despite recommendations to avoid the use of potentially inappropriate medications (PIMs) in older adults, the prevalence of PIM use is high in different settings including residential aged care. However, it remains unclear what the costs of these medications are in this setting. The main objective of this study was to determine the costs of PIMs in older adults living in residential care. A secondary objective was to examine if there was a difference in costs of PIMs in a home-like model of residential care compared to an Australian standard model of care.MethodsParticipants included 541 participants from the Investigation Services Provided in the Residential Environment for Dementia (INSPIRED) Study. The INSPIRED study is a cross-sectional study of 17 residential aged care facilities in Australia. 12 month medication costs were determined for the participants and PIMs were identified using the 2015 updated Beers Criteria for older adults.ResultsOf all of the medications dispensed in 1 year, 15.9% were PIMs and 81.4% of the participants had been exposed to a PIM. Log-linear models showed exposure to a PIM was associated with higher total medication costs (Adjusted β = 0.307, 95% CI 0.235 to 0.379, p < 0.001). The mean proportion (±SD) of medication costs that were spent on PIMs in 1 year was 17.5% (±17.8) (AUD$410.89 ± 479.45 per participant exposed to a PIM). The largest PIM costs arose from proton-pump inhibitors (34.4%), antipsychotics (21.0%) and benzodiazepines (18.7%). The odds of incurring costs from PIMs were 52% lower for those residing in a home-like model of care compared to a standard model of care.ConclusionsThe use of PIMs for older adults in residential care facilities is high and these medications represent a substantial cost which has the potential to be lowered. Further research should investigate whether medication reviews in this population could lead to potential cost savings and improvement in clinical outcomes. Adopting a home-like model of residential care may be associated with reduced prevalence and costs of PIMs.

A pilot study exploring staff acceptability of a socially assistive robot in a residential care facility that accommodates people under 65 years old.

ABSTRACTSocially assistive robots have successfully been trialed in residential care facilities (RCFs) for older adults. These robots may have potential for younger adults (i.e. under 65 years old) who also live in RCFs. However, it is important to investigate staff acceptability and ease-of-use of these robots. This pilot study used the Technology Acceptance Model to investigate how staff working in a specialized RCF for younger adults accept Betty, a socially assistive robot who was introduced in the facility for 12 weeks. Twenty-four staff completed pre-questionnaires, reporting that they thought Betty would have the ability to engage and entertain the residents they cared for. While there were only eight staff who completed the post-questionnaires, there were significant improvements compared to the pre-questionnaire results in areas such as residents enjoying the contact and activities. Impacting on ease-of use were technical difficulties. Although this study had limitations and could be improved by a better response rate and investigating the residents' acceptability of Betty, this study is one of the first to report that this novel technology may have much potential for engaging adults in RCFs.

Falls, Depression, and Other Hospitalization Risk Factors for Adults in Residential Care Facilities.

Prior research has shown a relationship between falls, hospitalizations, and depression among older adults in nursing home settings, but few studies have explored these relationships for younger and older adults in residential care facilities. This study examined risk factors for hospitalizations among assisted living residents. Using the 2010 National Survey of Residential Care Facilities, the study found that 24% of residents had a hospital stay in the past year. Residents with falls were more than twice as likely to have a hospitalization. For younger residents, depression was a key risk factor (OR = 1.74, p < .01). However, older residents with dementia had a lower risk of hospitalization (OR = 0.71, p < .01). More attention is needed to prevent falls and identify residents with depression and severe mental illness, who are at greater risk of hospitalization. Reducing avoidable hospitalizations can improve well-being for older and younger adults in residential care facilities.